DE2919935A1 - DEVICE FOR GUIDING SURGICAL INSTRUMENTS IN CONVERSION OSTOTOMY ON HUMAN BONE - Google Patents

Description

Gerhard Hug GmbH
At the Kirchenhürstle 4
7801 Umkirch

Device for guiding surgical instruments the conversion osteotomy on the human hip bone

The invention relates to a device for guiding surgical instruments during intertrochanteric adjustment osteotomy on the human hip bone, namely to prepare the bearing of a - from a mounting plate and an approximately right-angled blade that can be inserted into the bone - osteotomy plate on or in the bones of the femoral neck and femoral head.

Corrective osteotomies are among the most important and most common operations on the human hip joint. The main indication are congenital malalignments which, by correcting the axial relationships to the norm, eliminates serious incorrect stresses on the joint and so that the development of osteoarthritis can be prevented, on the other hand, existing osteoarthritis or femoral head Deformities and diseases in which the surgical repositioning of the position between the thigh shaft and femoral head even better preserved or better congruent parts of the joint with the acetabulum in the main stress zone of the hip joint.

The so-called intertrochanteric adjustment osteotomy has proven to be the best surgical procedure worldwide that of the thigh bones just below the femoral neck between the large and small rolling hillocks (trochanter major and lesser trochanter), a corresponding bone wedge removed and then the osteotomy site stabilized with a plate fixation

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will. Today, the osteotomy plate is mostly used as the osteosynthesis device used, the plate part of which is attached to the thigh shaft with appropriate screws and its blade, bent perpendicular to it, hammered into the cancellous bone of the femoral neck and femoral head will. Since the blade is at right angles to the plate, you can use the Screw the osteotomy site using appropriate tensioning devices be compressed, whereby the stability of the osteosynthesis becomes quite great.

In intertrochanteric osteotomies, changes in the position of the femoral head are made in all three planes Performed alone or in combination: changes in the femoral neck angle in the frontal plane are called varization when they are reduced and valgization when they are enlarged. Tilting of the femoral head in the sagital plane forward as flexion, backward as extension. The third correction can be the rotary position of the leg can be changed in the form of internal or external rotation. Such original osteotomies require especially if postural corrections are to be carried out in several levels (changes in one level always also repercussions on the effective angle of other planes, e.g. B. creates any inflection or extension at the same time an additional varization) very precise preoperative planning after x-rays and Drawings.

Today's surgical technique often destroys exact planning, as it is essential in terms of precision leaves a lot to be desired and is mainly dependent on the surgeon's good judgment. The surgical technique used today looks like this: To determine and mark the various angles and directions, small measuring triangles are held on the bone and thin KIRSCHNER drill wires are placed in the bone

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drilled. So are z. B. with a combined flexion and varization osteotomy five drill wires required: The first drill wire to mark the direction of the femoral neck, the second to mark the later seat of the insert in the frontal plane or the angle of variance, the third to mark the flexion angle in the sagittal plane, the fourth and fifth drill wire each above or below the later osteotomy site to mark the rotational position.

The crucial step of the operation is then the preparation of the position of the blade of the osteotomy plate in the femoral neck. The position of the blade alone determines the later position of the femoral head, since it is right-angled The shape of the osteotomy plate is always the femoral shaft at right angles to the plate blade is fixed. The seat of the blade in the femoral neck is prepared in such a way that first three side by side with a drill horizontal bores created and then the so-called seated instrument is hammered in that has the same profile as the plate blade. When pre-drilling and hammering in the seated insert instrument the surgeon strive strictly for the different planes and directions, exactly parallel to all three at the same time marking drill wires - direction of the femoral neck, direction of the angle of varization or valgization, Direction of the flexion or extension angle - to stay, which is extremely difficult and often very imprecise.

Then the bone is removed with an oscillating saw using a corresponding bone wedge one cut parallel to the seated instrument, the other perpendicular to the thigh shaft. For the The stability of the subsequent osteosynthesis is crucial here that the osteotomy is at the correct distance (15-20 mm) below the blade seat. Too little distance can cause the plate to break out of the

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Guide bones, too great a distance means that the osteotomy is no longer intertrochanteric, whereby on the one hand the plate can no longer be fully hammered, on the other hand the biomechanics because of the different muscle attachments located in this bone area is adversely affected.

After the osteotomy, the seated insert instrument is knocked out again and placed in the prepared bed the blade of the osteotomy plate hammered in. It follows the compression of the osteotomy site with the usual plate tensioner and then the fixation of the plate on the thigh shaft with screws, whereby the exact rotational position of the thigh shaft resp. a possibly desired change of the rotary position again based on previously inserted drill wire pins and a stopped measuring triangle must be observed.

The description of the surgical technique is intended to make it clear that the surgeon uses the constant orientation numerous drill wires is a difficult and imprecise process. Experience has shown that larger inaccuracies arise additionally by the fact that the thin drill wire pins often bent intraoperatively as they are necessary for other manipulations, such as pre-drilling the insert seat with a drill or osteotomy with a bone saw are quite a hindrance. Significant disadvantage of these wires is also that they often injure the gloves of the surgeon, and thus impair sterility to lead.

The invention is therefore based on the object of a device of the type mentioned at the outset, with which the accuracy of the surgical technique is increased considerably and at the same time the operation can be simplified and shortened in time, in particular the use the drill wire pins should be avoided.

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To solve this problem, the device is characterized by a and which can be placed on the thigh bone fixable fastening element and one that can be adjusted about two axes at right angles to one another, Guide device that can be placed at the surgical site for the necessary for making the opening for the blade Tools. With such a device, the exact position can be determined after the appropriate angle has been established adjust the blade of the osteotomy plate before the operation actually begins. Correspondingly faster carry out the operation, with the guiding device the annoying and expensive drill wire pins makes superfluous and yet results in a more precise arrangement of the bearing of the osteotomy plate.

It is particularly _expedient} when a fixable to the thigh shaft engagement arm as a fastening element and a perpendicular to the extension thereof and approximately tangentially oriented to the bone cross-sectional axis pivotable and fixable guiding device with at least one guide groove and a bearing face for applying against those bone region which the blade of the osteotomy receives, are provided, x ^ obei the guide recess corresponding to the blade cross-section can be rotated and fixed about an axis running approximately perpendicular to the contact surface and at right angles to the pivot axis between the guide device and the contact arm. After the device has been adjusted and fixed in the correct position on the thigh bone, the guide opening for the instruments is then located exactly above the point at which the plate bearing is to be attached in the form of a corresponding opening in the bone. The two setting options allow a very precise setting for precise "aiming" with the appropriate instruments,

The guide recess in the direction of its rotation

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axis and the axis of rotation can preferably be arranged in the center of the guide recess. this allows a corresponding tilting of the recess and thus also of the later blade seat depending on the direction of orientation of the bone wedge to be removed z. B. at a Flexion osteotomy. The contact arm can be bent or the like. Deformation as a transition from its contact area to the bearing point of the pivot axis for the guide device corresponding to the arc between the thigh shaft and the area of the femoral neck on this have facing away from the side. It is particularly useful if the Blade of the plate bearing - namely either approximately in the direction of the femoral neck (varization osteotomy) or, in the same plane, but across the femoral neck (valgization osteotomy) - at least two different Angled contact arms can be interchangeably connected to the guide device. In practice it is It is then a device or device kit for adapting to different anatomical requirements.

An embodiment of the invention of very particular importance is characterized by an in the guide recess the guide device matching drill bushing with adjacent holes as guides for one Drill for pre-drilling the opening for the seated insert instrument. Correspondingly quickly and precisely, with Help of the device according to the invention and this additional Part of the jig kit, the point where the seated insert instrument is to be pre-drilled should be hammered in to prepare the blade store. This process is also correspondingly precise and fast feasible.

Another embodiment to improve the surgical technique can consist in that the guide device

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preferably a second guide opening as a marking hole between the rotating part and its pivot bearing for pre-marking the upper boundary of the bone wedge to be removed. It is also used for marking a possible rotational movement advantageous if the contact arm has at least one guide opening as Has marking hole for a rotational movement between the femur shaft and femoral neck bone. These Marking holes can be used to place drills with which the corresponding markings on the bone can be attached. If the two bone parts are then separated, they can be based on the corresponding Markings are reassembled in the correspondingly desired angular position.

Overall, the device according to the invention therefore allows the precise setting of the changeover osteotomy intended angle of both the frontal plane and the sagital plane. With a substantial simplification the entire surgical technique is at the same time a high accuracy and a shortening of the Operation time achieved. Further refinements of the invention, some of which are of considerable importance, are the subject matter further claims.

The invention and its essential details are given below with reference to the drawing described. It shows in a partly schematic representation:

1 shows a device according to the invention after adjustment and attachment to a hip joint bone for a valgization osteotomy with 25 degrees valgization and a drill bushing and a drill bit is attached to pre-drill the plate bearing,

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FIG. 2 shows a representation corresponding to FIG. 1 for a varization osteotomy at a varization angle of 25 degrees, with a seated instrument already fixed,

3 shows a rear view of the device, which in this case is also used for a flexion osteotomy is set and provided,

A shows a representation corresponding to FIG. 1, at which through additional marking openings on the one hand the top of the to be removed Bone wedge and, on the other hand, the rotational position of the device in relation to the bone shaft with the help of Drill bits are marked,

5 shows the attachment of a chisel-like insert seat device, the cross section of which is approximately that of the blade corresponds to the osteotomy plate after the opening according to FIG. 1 has been pre-drilled,

6 shows the removal of the device according to the invention over the plate seating device,

7 shows how the actual osteotomy is carried out parallel to the seated insert instrument and vertically to the femoral shaft according to the pre-marking made,

8 shows the rear view of the corrected bone after attachment of the osteotomy plate and

FIG. 9 shows a side view corresponding to FIG. 8.

A device designated as a whole by 1 is used to guide surgical instruments during preparation of the bearing of an osteotomy plate 2 (Figs. 8 and 9), the

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consists of a fastening plate 3 and a blade 5 which can be inserted in the bone in the region of the femoral neck 4 and serves to hold together and compress the severed bone parts after the osteotomy. Above all, the opening for this blade 5 must be on the bone as precisely and quickly as possible be attached.

The device according to the invention has one on the thigh shaft 6 fixable contact arm 7 as a fastening element and a guide device to be described in more detail 8, the various adjustment movements to adapt to different cutting angles allowed by the bone. The guide device is perpendicular to the extension of the contact arm 7 and axis 9, oriented approximately tangentially to the bone cross-section, can be pivoted and in any pivoting position definable. It has a guide recess 10 and a contact surface 11 for placing against that bone area 12, which later receives the blade 5 of the osteotomy plate 2. The mentioned guide recess can be seen 10 particularly good in the plan view of FIG. 3, where it is indicated at the same time that this is approximately the blade cross-section corresponding guide recess 10 around an approximately perpendicular to the contact surface 11 and at right angles to the pivot axis 9 extending axis 13 is rotatable and fixable. This results in addition to the first setting option by appropriately applying the contact arm 7, two setting options on the guide device through their Pivoting relative to the abutment arm 7 about the axis 9 as well as the rotatability of the guide recess 10 to the Axis 13. The recess can be oriented correspondingly precisely in that direction in which the bearing or the opening for the blade 5 is to be made in the bone.

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It can be seen in FIGS. 1 to 5 that the guide recess 10 extends in the direction of its axis of rotation 13 and this axis of rotation 13 is arranged in the center of the guide recess 10. From FIG. 3 one recognizes clearly how this rotatability of the guide recess 10, the later position of the blade cross-section can be preselected relative to the bone in which in this way a flexion or extension osteotomy can be carried out, which due to the pivotability of the guide device 10 at the same time a valgization or varization osteotomy may be superimposed. 3 shows a flexion osteotomy.

In Fig. 1 it can be seen that the contact arm 7 has a bend 14 or the like. Deformation as a transition from its contact area 7 a to the bearing point 15 of the pivot axis 9 for the guide device 10 corresponding to the arc 16 has between the thigh shaft 6 and the region 17 of the femoral neck on the side facing away from this. As a result, the anatomical conditions are taken into account in such a way that on the one hand the contact arm 7 as a fastening element can be securely fixed on the thigh shaft 6, while the guide device is good can rest on the bone area 17 where the bearing for the osteotomy plate 2 is to be attached.

The comparison of FIGS. 1 and 2 shows that for different Guide directions of the blade 5 - namely either according to FIG. 2 in the direction of the femoral neck or 1 in the same plane, but transversely to the thigh neck - two different angled contact arms 7 can be connected to the guide device 8. Depending on the correction to be carried out - either according to FIG. 1 one Valgization osteotomy or a varization osteotomy according to FIG other system arm 7 preselected and then the corresponding one

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Adjustment of the various angular positions carried out. It is therefore the case according to the invention Device practically around a device kit.

1 to 6 it can be seen that in the area of the pivot axis 9 between the contact arm 7 and the guide device 8, a preferably two-sided angular scale 19 is provided on which in the manner shown the The angle between the contact arm and the drill and thus the angle between the thighbone and the plate bearing can be preselected before performing the osteotomy, the scale from a mean value to two Sides increases in order to adjust valgization and varization osteotomy in the same way. In Fig. For example, a valgization osteotomy is set at an angle of 25 degrees. Fig. 2 shows an adjustment a varization osteotomy also below 25 degrees.

According to FIG. 3, the contact arm 7 is in the area of the pivot axis 9 is fork-shaped and engages over an extension 18 of the guide device 8 on both sides, with this guide approach 18, the aforementioned angular scale 19 is preferably provided on both sides, so that the Device can be used for both the left and right thigh bones ipt. At the plant arm 7 is in In the area of the pivot axis 9, a pointer 20 is preferably formed in one piece, preferably on both sides, which protrudes into the area of the respective angular scale 19. You can see this particularly well z. B. in Figs. 1 and 2, where this pointer 20 fixedly connected to the contact arm 7 shows the corresponding angle on the relative to him swiveling scale indicates.

In the exemplary embodiment, the pivot axis 9 between the contact arm 7 and the guide device 8 is designed as a screw, whose mating thread in one of the holes of the fork

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shaped part of the contact arm 7 is provided so that a mother is unnecessary. To set a set angle between the contact arm 7 and the guide device 8, this screw serving as a pivot axis 9 is provided at the same time as a clamping screw. Accordingly is stepless adjustment possible.

The rotatable guide part 21 having the guide recess 10 on the guide device 8 is in one Slotted at least on one side, preferably expandable and contractible by a further clamping screw 22 Clamping ring 23 is arranged, which in the exemplary embodiment has a scale 24 on its outside for marking the flexion or extension osteotomy. One recognizes z. Am 4 shows the setting of 15 degrees of flexion on this likewise rising from a zero position to two sides Scale 24.

In the exemplary embodiment, the clamping screws have Allen openings 25, which are preferably the same so that both screws can be operated with the same tool. The clamping screw, which simultaneously serves as the pivot axis 9, has both an Allen opening 25 and a Outer polygon head 26, so that here, if necessary, a wrench with a correspondingly greater force can be set.

In Fig, 1 it can be seen that the with a clamp or forceps, the jaws 27 are indicated, on the thigh bone fixable abutment arm 7 has pointed projections 28 directed against the bone as displacement locks in order to the later work on the device 1 to prevent its unwanted displacement.

In Fig. 3 it can be seen that the guide recess 10 has a rectangular contour corresponding to the outer contour of the Has blade 5 of the osteotomy plate 2. Furthermore, it is

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placed that the guide recess 10 in the rotating part 21 a one-sided extension 29 corresponding to a pull-out projection 30 on a seated insert instrument to be described 31, which serves to prepare the opening for the blade 5, so that the device 1 after this insert-seated instrument 31 has been knocked in, it can be removed from the thighbone before it is removed is what is shown in FIG. The seated insert instrument 31 serves to preform the bearing for the blade 5, The seated insert instrument is only hammered in when the corresponding pilot holes have been drilled into the bone are made. Later forms the seated insert instrument hammered in with the help of the guide device 8 31 at the same time a parallel guide for the saw to carry out a first severing cut through the Bones according to FIG. 7.

The device also includes a drill bushing that fits into the guide recess 10 of the guide device 8 33 with adjacent holes as guides for a drill 34 for the already mentioned pre-drilling of the Opening for the seated insert instrument 31. The drill bushing 33 and the drill 34 interacting with it can be seen in Fig. 1. The drill bushing that fits into the narrow rectangle of the guide recess 10 expediently three closely spaced parallel bores 35, in which the outer distance of the outer bores corresponds almost to the width of the seated instrument 31. The seated instrument can be correspondingly easily Hit 31 when these three holes are next to each other. These can be Drill holes very precisely at the preselected angle relative to the thigh bone, because they go through the drill bushing 33 are well guided, which in turn is precisely aligned by the guide device 8. Corresponding after removal of the drill bushing, the seated instrument 31 can also be precisely used with the aid of the

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-Jit-

Drive the guide device 8 into the bone. You can still see that the outer contour of the inner contour the guide recess 10 corresponding drill bushing 33 on its in the functional position facing away from the bone Side has a handle 36, which od on a stop plate 37. The like. Is provided. This record 37 can at the same time prevent a possible slipping along the drill bushing when the drill is applied.

3 and 4 it can be seen that the guide device 8 between the rotatable guide part 21 and the pivot bearing penetrated by the axis 9, a second Guide opening in the form of a marking hole 38 for Pre-marking the upper boundary of the bone wedge 39 to be removed, the marking according to FIG Fig. 4 in a simple manner with the tip 40 of a drill, for. B. the drill 34 can be made. This can a simple and effective way of preventing the osteotomy from possibly being incorrectly spaced takes place below the blade seat.

In the same figures it can also be seen that the contact arm 7 in the exemplary embodiment also has a guide opening as a marking hole, which controls a rotational movement between the femoral shaft and the femoral neck bone can be. Is through the guide opening again with a drill bit 40, the original position of the device marked relative to the blade seat, a corresponding accurate rotation can be performed between the two bone parts. In doing so, it can be beneficial as an aid be when the width of the feed arm 7 on both sides of the marking hole 41 located on its center, respectively corresponds to a bone circumference proportion of 25 degrees. These are often around in this area Rotation corrections. The contact arm 7 is longer

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as the fastening plate 3 of the osteotomy plate and the Markie.rungslochung 41 is located on the contact arm 7 in that area by which the contact arm 7 is longer than this mounting plate 3, so that too after placing this plate the marking is still visible. The width of the contact arm and the width the mounting plate can correspond to each other. In any case, it is advantageous if the middle of the fastening plate 3 of the osteotomy plate from its edges each corresponding to a 25 degree rotation Distance. After applying the plate after attaching the blade, the corresponding rotation can be made be estimated relative to the marking or possibly also measured more precisely, after which the fastening plate the osteotomy plate can be screwed to the bone in a known manner, as shown in Fig. 8 and 9 show.

Overall, the device 1 according to the invention allows an intertrochanteric conversion osteotomy in which the duration of the operation is reduced and the surgical technique is simplified. It is possible to start with the Device the planned blade angle of the osteotomy plate in the frontal plane and at the same time the angle of rotation can be precisely set in the sagittal plane using the angular graduations on the device. Now the Device z. B. be attached to the femoral shaft by means of a conventional Lambotte forceps, after which the guide device 8 the corresponding tools, namely first the drill, then the insert-seated instrument 31, guides exactly. In addition, the device is used to determine the correct osteotomy height and the rotational position of the femoral shaft in the already mentioned way marked. The device thus replaces the previous one for marking the various levels and directions commonly used measuring triangles and numerous drill wires with their disadvantages

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Inaccuracy and risk of injury as well as extending the duration of the operation. At the same time the already mentioned
higher accuracy with simultaneous strong simplification
and thus shortening the entire operation is achieved.

All features and construction details shown in the description, the claims and the drawing can be used as well individually as well as in any combination with one another are of essential importance.

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Claims (25)

Gerhard Hug GmbH Am Kirchenhürstle A Umkirch claims 1. Device for guiding surgical instruments the conversion osteotomy on the human hip bone, namely to prepare the bed one - from one Fastening plate and a blade that is approximately at right angles to it and can be inserted into the bone - Osteotomy plate on or in the bone of the femoral neck and femoral head, marked by a fastening element (7) that can be placed and fixed on the thigh bone (6) and one opposite it adjustable about two axes (9; 13) at right angles to one another at the surgical site Attachable guide device (8) for the necessary for making the opening for the blade (5) Tools. 2. Device according to claim 1, characterized in that that on the thigh shaft (6) fixable contact arm (7) as a fastening element and around a perpendicular to the extent thereof and approximately tangentially to the bone cross-section oriented axis (9) pivotable and fixable guide device (8) with at least one guide recess (10) and a contact surface (11) to rest against the bone area (12) that receives the blade (5) of the osteotomy plate (2), are provided, the guide recess (10) corresponding approximately to the blade cross section by approximately perpendicular to the contact surface (11) and at right angles to Pivot axis (9) between guide device (8) and contact arm (7) extending axis (13) rotatable and fixable is. 030047/0449 * " ^{/ 2} 3. Apparatus according to claim 1 or 2, characterized in that the guide recess (10) in the direction its axis of rotation (13) and this axis of rotation is preferably arranged in the center of the guide recess is. A. Device according to one of claims 1 to 3, characterized in that the contact arm (7) has a bend (14) or the like. Deformation as a transition from its contact area (7 a) to the bearing point (15) of the pivot axis (9) for the guide device (10) corresponding to the arch (16) between the thigh shaft (6) and the area (17) of the femoral neck on the side facing away from it. 5. Device according to one or more of claims 1 to 4, characterized in that for different Guide directions of the blade (5) - namely either approximately in the direction of the femoral neck (A) (varization osteotomy) or in the same plane, but across the femoral neck (valgization osteotomy) - at least two different cranked abutment arms (7) can be interchangeably connected to the guide device (8) are. 6. Device according to one or more of claims 1 to 5, characterized in that in the area of Pivot axis (9) between contact arm (7) and guide device (8), a preferably two-sided angular scale (19) is provided. 7. Device according to one or more of claims 1 to 6, characterized in that the contact arm (7) is fork-shaped in the area of the pivot axis (9) and has a projection of the guide device (8) on both sides overlaps and that preferably on this guide extension (18) the angular scale (19) in particular is provided on both sides. 047/0449 / 3 8. Device according to one or more of claims 1 to 7, characterized in that on the contact arm (7) in the area of the pivot axis (9), in particular on both sides, a pointer (20) or the like. Preferably is integrally formed, which protrudes into the area of the respective angular scale (19). 9. Device according to one or more of claims 1 to 8, characterized in that the pivot axis (9) between contact arm (7) and guide device (8) is designed as a screw, the mating thread of which is preferably in one of the perforations of the fork-shaped Part of the contact arm (7) is provided. 10. The device according to one or more of claims 1 to 9, characterized in that for setting one set angle between the contact arm (7) and the guide device (8) serving as the pivot axis (9) Screw is also provided as a clamping screw. 11. Device according to one or more of claims 1 to 10, characterized in that the rotatable guide part (21) on the guide device (8) in one Slotted at least on one side, preferably expandable and contractible by a clamping screw (22) or the like Clamping ring (23) is arranged, which preferably has a scale, in particular on its outside (24) or the like. 12. The device according to one or more of claims 1 to 11, characterized in that the guide recess (10) a right-angled contour corresponding to the outer contour of the blade (5) of the osteotomy plate (2) having* 13. The device according to one or more of claims 1 to 12, characterized in that the guide aus- 030047 / 0Ui * " ^{/ A} Recognition (10) in the rotating part (21) a unilateral extension (29) corresponding to a pull-out projection (30) on the seated insert instrument (31) for preparing the Has an opening for the blade (5), so that the device (1) after hammering in this seat-insert instrument (31) can be removed from the femur before it is removed. 14. Device in particular according to one or more of the preceding claims, characterized by an in the guide recess (10) of the guide device (8) matching drill bushing (33) with side by side Perforations as guides for a drill (34) for pre-drilling the opening for the seated insert instrument (31). 15. Device according to one or more of claims 1 to 14, characterized in that the drill bushing (33) has three parallel bores lying close to one another, where the outer distance of the outer bores is almost the width of the seated instrument (31) corresponds. 16. Device according to one or more of claims 1 to 15, characterized in that the outer contour of the drill bushing (33) is the inner contour of the guide recess (10) and on its side facing away from the bone in the functional position, a handle (36) or the like. is provided in particular on a stop plate (37). 17. Device according to one or more of claims 1 to 16, characterized in that the with the help of the guide device (8) hammered seated insert instrument (31) at the same time a parallel guide for the saw (32) for making a first severing cut through the bone. / 5 030047 / CUAB 18. Device according to one or more of claims 1 to 17, characterized in that the guide device (8) preferably between the rotating part (21) and the Pivot bearing or the pivot axis (9) has a second guide opening as a marking hole (38) for pre-marking the upper limit of the bone wedge to be removed or the like. 19. Device according to one or more of claims 1 to 18, characterized in that the contact arm (7) has at least one guide opening (41) as a marking hole for has a rotational movement between the femur shaft (6) and the femoral neck bone (A). 20. Device according to one or more of claims 1 to 19, characterized in that the contact arm which can be fixed with a clamp or the like on the thigh bone (6) (7) pointed projections (28) or the like. Has shift locks directed against the bone surface. 21. Device according to one or more of claims 1 to 20, characterized in that the contact arm (7) is longer than the fastening plate (3) of the osteotomy plate (2) is and that the guide opening (41) is arranged on the contact arm (7) in the area around which the Contact arm (7) is longer than the mounting plate (3). 22. Device according to one or more of claims 1 to 21, characterized in that the width of the contact arm (7) on both sides of that located on its center Guide opening (41) each corresponds to a bone circumference portion of 25 degrees. 23. Device according to one or more of claims 1 to 22, characterized in that the width of the contact arm (7) corresponds to the width of the fastening plate (3) 030047/0449 speaks and the center of the mounting plate is offset from the edges by 25 degrees. 24. The device according to one or more of the preceding claims, characterized in that the clamping screws (9; 22) preferably have the same Allen openings (25). 25. The device according to one or more of the preceding claims, characterized in that at least the at the same time as a pivot axis (9) serving clamping screw both an Allen opening and a Has outer polygonal head (26). - Description - 00A7 / 0U9